Summary: When you have guaranteed issue rights, you can enroll in a Medicare Supplement plan without undergoing medical underwriting. There are specific situations in which you are granted guaranteed issue rights under the federal government, such as involuntarily losing your existing coverage. Additionally, you can also be granted guaranteed issue rights under state-specific laws. In this article, we’ll explain how guaranteed issue rights work and some common situations in which beneficiaries are granted these protections. Estimated Read Time: 7 min
What are Guaranteed Issue Rights For Medicare Supplement Plans?
Medicare Supplement guaranteed issue rights are a unique set of protections given to qualifying Medicare beneficiaries that allow them to enroll in a Medicare Supplement plan without underwriting.
When you have guaranteed issue rights, also called “Medigap protections”, an insurance provider cannot deny you a Medicare Supplement policy, or charge you more for your policy, due to current or past health problems. Additionally, providers must cover all of your pre-existing health conditions and cannot impose a pre-existing condition waiting period.
Medicare beneficiaries commonly receive guaranteed issue rights due to involuntarily losing coverage. However, there are additional situations, such as trial rights, that also grant guaranteed issue rights.
Do I Qualify for Medigap Guaranteed Issue Rights?
There are a few situations which will qualify you for Medigap guaranteed issue rights. When qualify for guaranteed issue rights, it’s important to understand what kind of policies you have the right to buy, and the timeframe you must apply for a policy.
There are situations in which you are granted guaranteed issue rights under federal law, and there are situations where you may be granted guaranteed issue rights under state law. Below, we’ll cover common situations in which you may qualify for Medigap guaranteed issue rights under federal law. You can contact your State Insurance Department to see if you have additional GI rights under your state’s laws.
Guaranteed Issue Rights When Losing Your Medicare Advantage Coverage
If you are currently enrolled in a Medicare Advantage plan, there are a few situations in which you will qualify for guaranteed issue rights to enroll in a Medicare Supplement plan. Regardless of your situation, you must return to Original Medicare before you can sign up for a Medigap policy.
If you move out of your Medicare Advantage plan’s service area, or your plan provider is leaving Medicare, you will qualify for guaranteed issue rights.
- You have the right to buy the following Medicare Supplement plans: A, B, C, D , F, G, K, or L
- You can buy a policy from any provider who offers Medigap policies in your state
- You can apply for a plan 60 days before your Medicare Advantage plan coverage ends, and no more than 63 days after your coverage ends.
*Plans C and F are only available to individuals who were eligible for Medicare prior to 1/1/2020
If you voluntarily leave your Medicare Advantage plan because the company did not follow Medicare’s rules or misled you, then you will qualify for guaranteed issue rights. You will have up to 63 days after your coverage ends to return to Original Medicare and use your GI rights to enroll in a Medigap plan.
GI Rights When Losing Employer Coverage that Supplements Original Medicare
If you have an employer group health plan, including retiree or COBRA coverage, that acts as secondary insurance to Medicare, you may qualify for guaranteed issue rights if that coverage is ending.
- You will have the right to enroll in Medigap Plan A, B, C, D, F, G, K, or L
- You can buy one of the above plans through any carrier that offers Medicare Supplement plans in your state
*Plans C and F are only available to individuals who were eligible for Medicare prior to 1/1/2020
Under this guaranteed issue right, you will have 63 days to enroll in a Medicare Supplement plan. The start of this timeframe will depend on which of these three dates occurred the latest: the date your current coverage ends, the date on the notice stating that your coverage is ending, or the date on a claim denial (if this is the only way you know that your coverage has ended).
Some states offer additional rights to individuals who are in this situation. If you are losing your employer health plan that acts as a secondary insurance to Medicare, contact your State Insurance Department to check if you have any additional rights under state law.
Guaranteed Issue Rights When Losing Your Medigap Coverage
Losing your Medigap coverage involuntarily will qualify you for guaranteed issue rights. For example, this may occur if your Medigap plan carrier goes bankrupt and as a result you lose coverage.
- You will be able to purchase Medigap plan A, B, C, D, F, G, K, or L
- You can purchase your plan through any carrier in your state
- You will have up to 63 days after your Medicare Supplement plan coverage ends to purchase a new plan
*Plans C and F are only available to individuals who were eligible for Medicare prior to 1/1/2020
It’s important to remember that this guaranteed issue right only occurs when you lose your coverage for reasons outside of your control. If you voluntarily drop your coverage, you will not be granted GI rights. There are exceptions:
If you have a Medicare Supplement plan and your plan carrier has not followed rules set by Medicare, or has misled or deceived you, you will be granted guaranteed issue rights when leaving your plan.
Medicare Trial Rights
Medicare trial rights give beneficiaries an opportunity to try a Medicare Advantage plan for a limited time without forfeiting the guaranteed issue rights that occur during the Medicare Supplement Open Enrollment Period. There are two trial rights that beneficiaries can use:
The first trial right occurs when you first become eligible for Medicare and choose to enroll in a Medicare Advantage plan or PACE (Program of All inclusive Care for the Elderly). If, within the first year of joining, you decide you’d like to return to Original Medicare and enroll in a Medicare Supplement plan, you can do so. You will have 60 days before your coverage ends and up to 63 days after your coverage ends to enroll in any Medigap policy that’s available in your state.
The other trial right occurs when you drop your Medigap policy to join a Medicare Advantage plan for the first time. If you’ve been in the plan for less than a year and decide you want to switch back, you can. You’ll have 60 days prior to your coverage end date and up to 63 days after your coverage ends to enroll in the Medigap policy you had before. If that policy is no longer available through the same insurance company, you can buy Medigap Plan A, B, C, D, F*, G, K or L from any carrier in your state.
Both trial right periods may have an extended duration under certain circumstances. Your State Insurance Department can provide more information.
Documents Required For Medicare Supplement Guaranteed Issue Rights
If you are using guaranteed issue rights to enroll in a Medicare Supplement plan, there are certain documents that the Medigap carrier you are enrolling with will require you to provide.
If you are leaving a Medicare Advantage plan, you will be required to show a dis-enrollment letter from your Medicare Advantage plan carrier. This letter must include your name and the date your coverage ends.
If you are using one of the two Medicare Trial Rights, you must prove your eligibility by providing documents from your previous Medicare Supplement plan, or documentation stating you enrolled in a Medicare Advantage plan less than 12 months ago and are new to Medicare. These documents can include proof of Medigap payment and ID cards with your current plan information.
Each carrier has slightly different requirements regarding what documents you must provide when using guaranteed issue rights. However, requirements will be communicated during the application process.
Don’t Qualify For GI Rights? Learn More about Medigap Enrollment
Even if you don’t qualify for guaranteed issue rights, you may still be able to get a Medicare Supplement plan. Below, you’ll find helpful resources for learning more about enrolling in Medigap coverage.
Medicare Supplement Open Enrollment Period
Enrolling in a Medicare Supplement plan during the MSOEP ensures your policy application cannot be declined. Read more and plan for your MSOEP by clicking below.
Medical Underwriting for Medigap Plans
If you don’t have guaranteed issue rights, you’ll need to undergo medical underwriting. Learn more about the process and which questions you can expect to answer here.
State-Specific Medigap Enrollment Rules
Your state may have state-specific enrollment periods that allow you to switch plans without underwriting. Learn more about Medicare rules by state here.
If you are unsure if you qualify for Medicare Supplement guaranteed issue rights, you can contact Medicare directly at 1-800-633-4227, or contact your State Insurance Department. For questions regarding GI rights and Medicare Supplement plans, you can also speak with one of our licensed insurance agents by calling the number above.
Sources
Get Ready to Buy: Your Medigap Open Enrollment Period, Medicare.gov. Accessed February 2023
https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy
